St. Bernardine Roman Catholic Church

Registration/Census Form

(Online)

Please provide us with the following information. Thank you for your assistance.

Please select one

New Registration

Census Update

Date

YYYY

Household Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

List SEPARATELY each person living in your household. Please list yourself first

Full Name

Include your middle name or initial.

First Name

Last Name

Are you a member of St. Bernardine Roman Catholic Church?

Gender

Birth Date

YYYY

Envelope Number

Do you wish to receive (or continue to receive) church envelopes?

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Marital Status

Religion

Baptized:

First Communion:

Confirmed:

Occupation, Activities,Skills, or Hobbies:

If member is a child, do they attend our Sunday School :

Grade

How can we minister to you?

Full Name

First Name

Last Name

Relationship to you

Member of St. Bernardine's?

Gender

Date of Birth

YYYY

Envelope Number

Do you wish receive (or continue to receive) church envelopes?

Cell Phone

(###)

###

####

Marital Status

Religion

Baptized:

First Communion:

Confirmed:

Occupation, Activities, Skills, or Hobbies:

If member is a child, do they attend our Sunday School:

Grade:

FullName

Please include middle initial or name

First Name

Last Name

Relationship to you:

Member of St. Bernardine's:

Gender

Birth Date

YYYY

Envelope Number

Do you wish to receive (or continue to) church envelopes:

Cellphone:

(###)

###

####

Email:

Marital Status:

Religion:

Baptized:

First Communion:

Confirmed:

Occupation, Activities, Skills, or Hobbies:

If member is a child, do they attend our Sunday School: